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Full text of "United States Navy Medical News Letter Vol. 26, No. 12, 23 December 1955"

Friday, 23 December 1955 



NavMed 369 



Vol. 26, No. 12 




UNITED STATES NAVY 




Editor - Captain L. B. Marshall, MC, USN (RET) 





Merry Ghristmas 

To: A U Bands, Medical 
Deparbierit of ttiS Savy 

A t ttiis yutettic season of \tPfe anJ oojjpassiou for ottjers , nany 
nenjbers of tiie HaiiGalDeparlijeritwill; fiie Hast, overseas, or 
asljoiB, are atbsdsUes, in opemting roonis, oratwoik limjedlcal 
laboiatories . in a isep sense tbesG dally tasks reveal tije spirit 
of Slirtetaias. 

file professions associatsd wittj ttje care aijd Ijealing of the sick 
aie ai?ong tije rpblest folbif ed by rpen and women. They have 
grown in significanoe arv3 scope during the years. To lie bve 
that iiispiial PiciBnce HighWngale and Doctor Osferti rcstons 
ahattersd It/es, we have added a store of scientific knowledge 
which tsday guides, infonss, arid iiproves ournedicalirilnlsby. 
The Savy has contobntsd its shars to these grsatadvanoes, 
In the spirit of tiie season, I felicHafe aU of you %Dughout ihe 
MedicalDepartojentaril ouriinends it) oUieriijilltary services arjd 
iri oli^IUat; pmctloG, who have advanced ujan's effective cotjtiDlof 
health pnDli^ii)s during the past year. We can shaie our satisfaction 
in tijese acconiplislMeiite. I took forward in corifident hope lhat In 
the nionths arjd years to f)oiiie,nedical scfenoewiH conquer njany 
ijore of the natural forces which deslroy , restrict, or sadden hunian 
Me. 

T you all and to oiir fciends everywhere, I extend heartfelt beat 
wishes fora Merry Shristnias and a Happy tiew Year. 

' BARTHOLOMEM M.HilJgik 
RearAdniralWGJ 
gurgeon&eneral.U. 8.}{avy 




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Medical News Letter, Vol. 26, No. 12 



TABLE OF CONTENTS 

U. S. Naval Dental School , 3 

Summary of Dental Research 7 

Clinical Experience with Warfarin ...„ 11 

Clinical Picture of Endocardial Fibroelastosis ., 13 

Tuberculosis Relapse Factors 15 

Surgery of Blood Vessel Grafts 16 

Disaster Relief Planning 19 

Training and Assignments in Diving Medicine 23 

"A Letter" , 24 

From the Note Book 25 

Instructions Relating to Diagnostic Titles (BuMed Notice 6310) 27 

Records Held or Destroyed (BuMed Inst. 5210. 2A) . , ,' 28 

Antibiotics, Extension of Potency Dates (BuMed Notice 6710) 28 

Defective Medical and Dental Material (BviMed Inst. 6710. 24) 28 

MEDICAL RESERVE SECTION 

"Atomic Medicine" - A New Correspondence Course 29 

Selection Board for Promotion to Captain 30 

AVIATION MEDICINE SECTION 

Laboratories Associated with Aviation Medicine 'Problems 30 

Hardheaded Use of the Hardhat 34 

Historical Facts - November and December 35 

Course in Aviation Medicine 37 

Flight Surgeons to Solo Again 37 

Designation of Naval Aviator. 38 

Joint Committee on Aviation Pathology 38 

Contributions for Aviation Medicine Section, Medical News Letter .... 40 



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Medical New3 Letter, Vol. 26, No. IE 



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Folic y 



The U.S. Navy Medical News Letter is basically an official Medical 
Department publication inviting the attention of officers of the Medical De- 
partment of the Regulalr Navy and Naval Reserve to timely up-to-date items 
of official and professional interest relative to medicine, dentistry, and 
allied sciences. The amount of information used is only that necessary to 
inform adequately officers of the Medical Department of the existence and 
source of such information. The items used are neither intended to be nor 
susceptible to use by any officer as a substitute for any item or article in 
its original form. All readers of the News Letter are urged to obtain the 
original of those items of particular interest to the individual. 



Due to critical shortage of medical officers, the Chief, Bureau of 
Medicine and Surgery, has recommended, and the Chief of Naval Personnel 
has concurred, that Reserve medical officers now on active duty who desire 
to submit requests for extension of their active duty for a period of three 
months or more will be given favorable oonsideration* 



The development of the U.S. Naval Dental School to its present 
position as the keystone of the career training of dental officers, is one that 
parallels the growth of the Naval Dental Service and the progress of civilian 
dentistry. The first in-service training of dental officers beyond their 
training in civilian dental schools was started in 1922, when Surgeon General 
Stitt established a Department of Dentistry at the U.S. Naval Hospital in 
Washington, D. C, , which was then located at the present site of the Bureau 
of Medicine and Surgery, Three dental officers were assigned to postgrad- 
uate study as instructors. This training responsibility was formally estab- 
lished as a dental school on 3 Feburary 1923. Initially, this school offered 
a three to four weeks' course which included some military indoctrination 
and some professional instruction. From 1923 to 1936, many of the newly 
commissioned dental officers of the Navy attended this course, but by 1936, 
all newly commissioned officers could not be accommodated. In f ebruary 
1942, the Naval Dental School moved to Bethesda, Md, , when it became 
a component command of the National Naval Medical Center. 



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Notice 



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The U. S. Naval Dental School 




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Medical News Letter, Vol, 26, No. 12 



The present mission of the Naval Dental School is to conduct post- 
graduate and graduate instruction for Dental Corps officers in the field 
of dentistry and in military medical subjects peculiar to the requirements 
of the Naval Service; to instruct and train dental technicians in the various 
technical specialties; to participate in the preparation of training aids for 
use by naval dental personnel; to prepare and administer correspondence 
training courses for the personnel of the Regular and Reserve components 
of the Dental Corps; and to provide dental treatment and consultation for 
the National Naval Medical Center, Bethesda, Md. , and to the profession- 
al activities, as required. To accomplish its mission, the School has 
five departments. 

i. Officer E ducation and Training Department 

The Officer Education and Training Department has the responsibility 
for giving instruction to dental officers that will enable them to stay abreast 
of current developments in dentistry and to meet the requirements for ad- 
vanced degrees and specialty board certification. This department con- 
ducts the various postgraduate courses, residency type training in oral 
surgery, prosthodontic s, periodontics and oral pathology, and specialized 
training in dental subjects required by the Naval Dental Service. 

a. General Postgraduate Course. This course, the most impor- 
tant and comprehensive in existence for the in-service training of naval 
dental officers is now a 10-months' course. The course is the means by 
which young dental officers are provided with the basic knowledge they 
need to discharge their duties as officers in dental clinics and departments, 
chiefs of dental services at naval hospitals, and research and staff assign- 
ments. This course is the avenue by which those officers with demon- 
strable aptitude are chosen for further advanced specialty training. 

b. Residency Type Training, Residencies in oral surgery, pros- 
thodontics, periodontics, and oral pathology have been developed to meet 
the educational requirements of the American Dental Association. This 
type of training is designed to bring those individuals who have been chosen 
for specialty training to the level where they may take the examination by 
the various dental specialty boards. 

c. Specialized Training, Courses in the various specialties of den- 
tistry are offered by the school as needed by the Naval Dental Service. 
These courses are usually offered to dental officers who have received 
some advanced training in a specialty, but who have had an intervening 
sea or foreign shore duty and who now require an extensive refresher 
course. 



Medical News Letter, Vol. 26, No. 12 



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An interesting supplement to the officer training program is the 
series of special lectures given twice each month throughout the school 
year. Outstanding men in the dental profession present discussions of 
timely subjects thus bringing to the school the latest information on pro- 
fessional problems, 

d. Casualty Treatment Training . As a part of all training, all 
students, officer and enlisted, are given a 35-hour course in casualty 
treatment training, providing practice in emergency treatment of casual- 
ties which might result from a major disaster. Treatment practice is 
made possible through the use of moulages and other special training 
devices which have recently been developed by U.S. Naval Dental School 
personnel. These devices present a series of realistic problems which 
permit the trainee to participate in the treatment of shock, hemorrhage, 
wounds, burns, and other emergency measures. 

2. The Clinical Services Department 

The Clinical Services Department provides clinical support to the 
U.S. Naval Hospital and other commands of the National Naval Medical 
Center, and also, upon request, to outlying naval activities. This treat- 
ment includes operative dentistry, crown and bridge, partial and full 
denture prosthesis, somatoprosthesis, endodontics, periodontics, roent- 
genology, and oral surgery. The clinical activities are supported by 
laboratories for pathology, bacteriology, and biochemistry. 

In addition to serving the needs of the school, the Oral Pathology 
Division provides a Navy-wide diagnostic service for histopathology 
examinations of tissue. Also, it is currently preparing a color atlas 
of oral pathology which promises to be of great help to the oral diagnos- 
tician. 

The department also supports clinical research projects. Inves- 
tigation of the cutting of tooth structure by ultrasonic vibratory mech- 
anisms has been pioneered at the School; this' investigation has received 
wide attention from the dental profession throughout the country. 

Another investigation, that has brought gratifying results, was the 
development of the water control valve for the operative dental unit. 
This device saves more than 90% of the water normally used during . 
patient treatment. 

3. The Correspondence Training Courses Department 

The Correspondence Training Courses Department plans, develops, 
and administers courses for dental personnel of the regular and reserve 



6 Medieal News Letter, Vol. 26^ No. 12 

components of the U.S. Navy. To aecomplish these duties most effec- 
tively, the department maintains liaison with the Bureau of Medicine and 
Surgery, Bureau of Naval Personnel, and the U.S. Naval Medical School 
on matters pertaining to correspondence training courses. 

Sixteen courses are available at this time. A course is now in 
preparation on the Administration of a Dental Department, and inquiries 
about the subject indicate that a wide-spread interest in it already exists. 
EnroUees in correspondence training courses have increased over 100% 
in the last few years and current enrollments reach nearly four hundred. 

4. The Enlisted Education and Tra ining Department 

This department offers three courses of instruction; 

a. The course in Dental Equipment, Maintenance, and Repair is 
of 10-months' duration. Although listed as a basic course, it is highly 
specialized, training students to repair and maintain standard dental 
equipment while also giving them a foundation of the principles of elec- 
tricity and machine tool operation. This consolidated course of instruc- 
tion, covering the equipment of all major dental manufacturers, has no 
counterpart in the military establishment or in civilian life. 

b. The course for Advanced General. Dental Technicians is of 

6 -months' duration, with an authorized quota of twenty students in the 
ratings of DT2, DTI, and DTC. The aim of the course is to prepare the 
dental technician to perform administrative duties and better prepare 
himself for advancement. The student receives instruction in property 
and accounting and clerical procedures, personnel management, and 
other subjects that will aid in the efficient operation of a dental facility. 

c. The course for Advanced Prosthetic Dental Technicians is of 

6 -months' duration with an authorized quota of ten students in the ratings 
of DT2, DTI, and DTC. The partial dentures section of the course pro- 
vides instruction in surveying, designing, and constructing precision- 
cast partials. In the complete dentures section, balanced set-ups, equil- 
ibrations, and characterization of the dentures are taught. Students are 
introduced to crown and bridge construction, including kn extensive study 
and fabrication of ceramics. The course is designed to prepare the tech- 
nician to supervise laboratories in the field. 

5. The Training Aids Depar tment 

The T raining Aids Department coordinates the evaluation, prepara- 
tion, and production of training aids which are used for the training of 
dental personnel throughout the Navy. In doing this, the department 



Medical News Letter, Vol, 26, No, 12 



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maintains liaison between the U.S. Naval Dental School and various 
bureaus and offices of the Department of Defense and civilian organizations. 
Departmental activities run chiefly along two lines, yet these are flexible 
and capable of expansion. One includes the preparation for publication of 
such aids as training manuals, study guides, handbooks, and other manu- 
script materials. The other includes the preparation for prbdu,ction of 
films, television programs, and the like. In a closely related type of 
activity, the department assists in an advisory capacity in the prepara- 
tion of exhibits for display at national scientific and professional meetings. 
(Naval Dental School, NNMC) 

sit * * * * * 

Summary of Dental Research 

During the last ten years, the dental research program has been 
primarily concerned with two chronic diseases, namely, dental caries 
and periodontal disorders. The high rate of attack of these two diseases 
has few parallels and, like many other chronic diseases such as mental, 
metabolic, and neoplastic disorders, they have been strikingly resistant 
to preventive measures. Other minor phases of the program have been 
concerned with restorative and corrective procedures and the science of 
dental materials as related to prosthetics and oral surgery. These studies 
have been conducted in clinics and laboratories and, in some instances, in 
collaboration with nearby universities. 

One of the cooperative studies with universities, started in 1947, has 
been responsible for many follow-up studies. CDff F. L. Losee, DC U^N, 
(then L,CDR) and LCDR R.S. Leopold, MCS USN (then LT) of the Naval 
Dental School, worked with Dr. W. C. Hess of the Medical and Dental 
School, Georgetown University. They investigated the components of 
dentin and enamel and fotjind that a portion of these two dental tissues was 
organic in nature. This helped to explain the passage of radioisotopes 
through dentin and enamel. It is thought that radioisotopes use the organic 
pathways in penetrating the teeth. Other studies are being pursued at the 
present time to determine if these organic pathways in teeth can be altered 
by nutritional means and, thereby, change the caries susceptibility of rat 
teeth. Perhaps the most important outgrowth of the original study has 
been in the field of experimental animal surgery. In the past, bone grafts 
have frequently been sequestrated from the new site in the host. This has 
been particularly true of homologous grafts. One theory, which has been 
advanced as the cause for failure of many homologous grafts, is an anti- 
genic reaction due to the organic content of the transplanted bone. CDR 
Losee, now with the Dental Division, Naval Medical Research Institute, 
has been able to remove the organic content of bone prior to the time it 



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Medical News Letter, Vol. 26, No, 12 



is transplanted. This has permitted heterologous grafts which, heretofore, 
have not been successful. In the preliminary studies to date, rat femurs 
and bovine bone have been successfully transplanted into dogs. These 
results are most encouraging and may ultimately lead to new techniques 
which can be applied to human patients. 

The flora and fauna of the mouth are more numerous and diverse 
than in any other region of the body. The role of these organisms in 
mouth infections and in the relation of mouth infections to systemic disease 
is not well known. The bacteriology of the normal as well as the diseased 
mouth is extremely complex. For instance, there is one view that the 
microorganisms found under pathological conditions are no more than an 
overgrowth of those normally found in the mouth. The ecology of these 
mouth habitants is extremely important — especially the antagonisms — 
and little is known about them. In spite of these difficulties, CDR C. A. 
Ostrom, DC USN, did make significant progress in the detection and 
identification of or ganisms which he seeded and recovered from the oral 
cavity. His early work in 1947 was with animals and later he refined and 
further developed the techniques and employed them in human volunteers. 
The technique has been used succes sfillly in recovering Mycobacterium 
tuberculosis organisms from tuberculous patients. This may have far 
reaching importance in the field of medicine as there is a chance of detect- 
ing and identifying pathogenic organisms prior to the development of clin- 
ical symptoms, ' , . 

In 1948, CDR C, E, Dawson, DC USN, and W. Blagg investigated 
the effect of human saliva on the cholera vibrio. They found that the 
saliva of certain patients exhibited antibacterial activity to this organism. 
More recently, CDR M. G. "Wheatcroft, DC USN, did similar immunologic 
studies in which he compared human blood serum and salivary antibody 
titers in cases of Brucella melitensis infection. He found correlations 
between the titers of these two body fluids and stated that it is probable 
that antibodies are transferred from the serum to the saliva. These 
studies were both conducted at Naval Medical Research Unit No. 3, Cairo, 
where there is an abundance of clinical material involving diseases which 
are uncommon in the United States. The full importance of the saliva in 
preventing air-borne and food-borne diseases has never been recognized, 
but these studies may lead to a better nfider standing of this approach to 
immunology. 

CDR (now Captain) J. A. English, DC USN, collaborated in 1948 
with general pathologists at the Naval Medical Research Institute in inves- 
tigating the effects of high dosages of radiation on oral tissues and on 
dental development. He found that physiologically active odontogenic ■ 
tissues were inhibited by x-ray irradiation at the epilation dose level 
{about 1500 r). In both swine and rats, tooth development was interfered 



Medical News Letter, Vol. 26* No. 12 



9 



with, to the extent that hypoplasia or more severe tooth deformation re- 
sulted. More recently in the same laboratory, enzymatic studies of 
radiated salivary gland tissues have been carried out by biochemical 
techniques. These studies have shown that, following radiation (1500- 
2000 r), there maybe a significant increase in specific enzyme activity 
in two enzymes involved in carbohydrate metabolism. These studies . 
are both directed toward learning more about the basic mechanisms 
involved in high dosage radiation of the kind that might occur in nuclear 
detonations. 

Stability of dental prosthetic appliances has been a major problem 
confronting the dental profession since the time replacement of missing 
teeth was first attempted. Improvement of techniques and materials and 
greater knowledge of the physiology and anatomy of the mouth have greatly 
reduced these problems. However, there is a small percentage of patients 
who have lost so much alveolar bone that comfortable functional dentures 
are extremely difficult to construct. In an effort to alleviate this condition, 
a cooperative study was initiated by CDRS C. H. Blackstone and M. L. Parke; 
at the Naval Dental School. This was done in conjunction with the Tissue 
Bank of the Naval Medical School and the Experimental Surgery Section 
of the Naval Medical Research Institute. Under surgical conditions, 
dogs' mouths were prepared for the grafting by removing four mandibular 
teeth and excising a section of the mandible from the crest of the alveolar 
ridge. The bone which was removed varied in dimension from 7 to 10 
millimeters. This surgical defect was rebuilt by various types of freeze- 
dried tissues and it was found that the freeze-dried homologous cartilage 
was the most successful of those tested. Clinically, the alveolar ridges 
retained the height and the contour which was established by grafting, and 
the grafts became fixed in from 2 to 6 weeks. Examinations were made 
at a later date of cross sections of the mandibles through the graft sites 
at various intervals of time (49,77, 126, and 217 days). Vascularization 
of the cartilage appears to occur early and is followed by osteogenesis. 
At approximately 220 days, complete replacement of the graft by a mature 
type of bone may be noted. Due to the success of the animal studies, man- 
dibles of four patients have been reconstructed with homologous freeze- 
dried cartilage for the purpose of providing more bony support for dentures. 
While these represent only a small series of cases, the results indicate 
that this may become a useful corrective procedure for this condition. 

Realizing the value of rats in the study of dental caries, CDR (now 
Captain) C. A. Schlack, DC USN, while on duty at the Naval Medical Re- 
search Institute, started to develop a strain of rats which were suscepti- 
ble to caries. By inbreeding, a susceptible strain of rats was developed. 
In subsequent studies, CDR F. L. Losee learned that these rats could be 
made to develop carious lesions in 30 days, whereas, it usually requires 



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Medical News Letter, Vol. 26, No. 12 



at least 100 days to develop caries in the stock Osborne-Mendel rat. 
Not only does this permit the completion of more studies in the same 
period of time, but it demonstrates that hereditary factors play an impor- 
tant role in determining the susceptibility to dental caries. 

For the past 8 years, dental research personnel at the Naval Train- 
ing Center, Great Lakes, 111. , have been primarily engaged in studies 
related to deiftal caries and periodontal diseases. The results of tests 
of 60 different dentifrices, which have been modified by either antibiotics 
or enzyme inhibitors, have shown that the dentifrices tested had little or 
no effect on certain organisms which when present in high counts are 
indicative oi caries activity. While these tests point to little hope for a 
therapeutic dentifrice, other studies are being continued. 

In another investigation, experimental caries have been produced 
in an "experimental mouth" designed and developed by B. A. Yocke, DT3, 
This device permits the in vitro study of caries and at the satee time allows 
the investigator to vary certain experimental conditions. While there is 
some doubt as to whether the lesions developed in this device are identical 
with human lesions, it does permit biochemical, microbiological, and 
nutiritional studies. For his c ontirilsution to dentistry, Yoeke received a 
letter of commendation from the Surgeon General. 

It has been reported that topical applications of sodium fluoride 
reduce the incidence of carious lesions in children. The suggestion was 
made that this method of reducing the formation of new lesions be employed 
in the Navy. Prior to initiating this as a preventive program, a controlled 
study was undertaken at Great Lakes. It was found that this method did 
not reduce the rate of new caries in the military age group. The results 
of this clinical study have saved the Navy time and money as this treat- 
ment procedure was not adopted as originally suggested. 

Another interesting study at Great Lakes, and in collaboration with 
the Dental School of the University of Illinois, has been their joint study 
of the healing capacity of the tissues in the pulp chamber. Many teeth 
which normally would have been extracted due to the advanced carious 
lesions have been treated by amputation of the diseased pulp followed by 
chemotherapy with antibiotics and other therapeutic agents. The results 
of the preliminary tests seierfi to indicate that some teeth perhaps can be 
treated and preserved. If more teeth can be retained, the requirement 
for dentures will be decreased. 

The Navy has been one of the pioneers in the field of magnetostric - 
tive dental cutting devices (ultrasonic dental drill). The Bureau of Med- 
icine and Surgery received a letter of recognition from the National 
Research Council for its valuable contribution in this field of endeavor. 
This has been largely the result of CDR A. C. Neilsen's efforts. He and 
Ms cGSWOfkers at the Naval Dentaf^l School found that the cutting device 



Medical News Letter, Vol. 26, No. 12 



U 



developed by the Navy caused undesirable effects in the teeth of guinea 
pigs. Thus, they have recommended to the profession to proceed with. 
caution until biological tests establish the safety ol this new cutting device. 

In summary, it can be said that the significant accomplishments of 
dental research have been instrumental in improving oral health. Through 
research, both independent and collaborative, dental science and medicine 
have become more closely associated and have more understanding of 
each others' problems. Finally, through the efforts of dedicated dental 
officers, enlisted technicians, and civilian scientists, dental research 
in the Navy has attained a status of high esteem and tremendous impor- 
tance as a major phase &f the Navy's research tsffoft. (DentRea, BuMed) 

!{c -jc :ic ^ >}: 

Clinical Experience with Warfarin ' 

Although the presently available anticoagulants have been of great 
clinical usefulness, well-recognized defects are inherent in them. Heparin 
requires frequent parenteral administration and is costly. Bishydroxycou- 
marin (Dicumarol) has a long latent period between the time of administra- 
tion and onset of therapeutic effect. Ethyl biscoumacetate (Tromexan) loses 
therapeutic effect within a few hours after reaching the therapeutic level, 
thus rendering smooth control of anticoagulant action difficult. Other of 
the newer anticoagulants possess undesirable side-reactions, A more 
nearly ideal anticoagulant continues to be a practical need. For this 
reason, a clinical study has been conducted on warfarin (Coumadin) 
sodium, one of the group of coumarin drugs produced by Dr. Karl Paul 
Liink and his group at the University of Wisconsin. The substance, 3- 
(a-phenyl-B-acetylethyl)-4-hydroxycoumarin, is highly active as a hypo- 
prothrombinemic agent, is soluble and #table, afld is suitable for intravenous 
use. 

The authors' use of warfarin sodium given intravenously as an anti- 
coagulant was begun in May 1953, and, in March 1954, he began use of 
tablets for oral administration. Ten cubic centimeter ampules of warfarin 
sodium containing 75 mg. of the drug were secured for intravenous use. 
Scored tablets prepared in 25 mg, size were used for oral administration. 

Patients with acute thrombophlebitis, pulmonary embolism, myo- 
cardial infarction, or Other conditions requiring anticoagulant therapy, 
were given initial dosage of 50 to 80 mg. of the drug either orally or intra- 
venously after determination of prothrombin time was accomplished. Pro- 
thrombin determinations were made daily at 8 a.m. thereafter and the 
required maintenance dose of the drug estimated. With few exceptions, 
attempts were made to aphieve constaht levels within the therapeutic 
range by daily dosage with warfarin sodium after the peak effect of the 



12 



Medical News Letter, Vol. 26, No, 12 



initial dose had been reached. Prothrombin tests were performed on 
100% plasma by the one-stage method of Quick with use of thromboplastin 
(Simplastin), and results were reported both as prothrombin time in seconds 
and as a percentage of normal prothrombin. Control prothrombin times 
were usually 13 seconds and rarely 12 or 14, which were considered 100% 
of normal. Whenever hypoprothrombinemia became excessive, or hemor- 
rhage of gross or microscopic proportions occurred, menadione sodiuna 
bisulfite or phytonadione (Mephyton) was administered parenterally in a 
single dose. 

The author treated 100 patients with warfarin sodium. All of the 
patients were adults; ages varied from 21 to 91 years. The series includes 
42 cases of myocardial infarction, 12 cases of intermediate coronary syn- 
drome (coronary insufficiency), 35 cases of acute thrombophlebitis, 7 cases 
of pulmonary embolism, 2 cases of congestive heart failure, and 2 cases of 
chronic auricular fibrillation preparatory to conversion to normal rhythm. 

Warfarin sodium is a rapidly acting anticoagulant drug, producing 
therapeutic hypoprothrombinemia in approximately 21 hours when admin- 
istered intravenously and in 24 hours when administered orally. Absorp- 
tion must be almost complete from the intestinal canal, because the response 
to doses given orally and intravenously is approximately the same with a 
delay of about three hours in the onset and peak of action when the drug is 
given orally- Heparin may be used during induction of therapeutic hypo- 
prothrombinemia as was done in 28 cases, provided care is taken that 
blood for prothrombin determination is not drawn within four hours of the 
administration of heparin. Rarely will it be necessary to use heparin 
therapy for more than 24 hours when warfarin is administered as the 
primary anticoagulant. 

Maintenance of smooth levels of hypoprothrombinemia proved to be 
relatively easy due to the prolonged action of the drug. In instances where 
the initial dosage of 75 mg. of warfarin sodium proved inadequate, sup- 
plenientaTy dosage corrected the defect without difficulty. Administration 
of phytonadione restored prothrombin to safe levels and led to clinical 
cessation of bleeding in all instances in which it was attributable to hypo- 
prothrombinemia. 

Warfarin (Coumadin) sodium has been used as the hypoprothrombi- 
nemia agent in 100 clinical cases requiring anticoagulant therapy. This 
substance is soluble and active by intravenous and oral administration 
in approximately the same dosage. The initial dose was given intraven- 
ously in 21 cases, orally in 79, Maintenance dosage was given intra- 
venously in 13 of the former group and orally in the remaining 87 cases. 
Therapeutic hypoprothrombinemia is induced in adults by an initial dose 
of approximately 75 mg, of the drug within an average of 21 to 24 hoars, 
depending upon the route of administration. The maintenance dose by 



Medical News Letter, Vol, 26, No. 12 



13 



the continuous method, based on frequent (daily) prothrombin determina- 
tions, varied among patients from 4 to 19 mg. , averaging about 10 mg. 
whether the drug was given orally or intravenously, and was consistent 
from day to day in the same patient. Prothrombin returned to normal 
levels after therapy with warfarin sodium was discontinued in an average 
of two days measured from the time of the last determination within 
therapeutic levels. 

Hemorrhagic phenomena occurred in 8 cases and were attributable 
to anticoagulant therapy in 5 of these cases (5%). They consisted of gross 
or microscopic hematuria A)(fhich cleared rapidly on administration of 
phytonadione. Menadione sodium bisulfite or phytonadione was admin- 
istered in 10 instances for various reasons and invariably produced sig- 
nificant elevation of the prothrombin level. No side effects (effects other 
than the ihduction Of hypoprothrombinemia) were encountered. None of 
the 4 deaths that occurred in patients of the series were attributable to 
anticoagulant therapy; clinical estimate of the results of anticoagulant 
therapy was uniformly good. It is concluded that warfarin sodium pos- 
sesses properties that make it more nearly an ideal anticoagulant than 
the other agents now available. (Colonel B. E. Pollock, MC USA, Clinical 
Experience with Warfarin (Coumadin) Sodium, A New Anticoagulant: 
J.A,M.A. , 159: 1094-1097, November 12, 1955) 



* * sft * « * 
Clinical Picture of Endocardial Fibroelastosis 

An entity, variously labeled as endocardial fibrosis, endocardial 
fibroelastosis, endocardial sclerosis, and subendocardial fibroelastosis, 
has become well established during the past decade. This is evidently 
the same disease process previously described as fetal endocarditis. 

The disease and its location suggest that endocardial fibroelastosis 
is probably the proper title. There seems to be at least two separate 
disease patterns characterized by this glistening, white, thickened 
endocardium: one occurring in infants and young children and a second 
in adult life. Although^the pathologic results appear similar in the two 
age groups, there is sufficient difference in the clinical picture to justify 
considering endocardial fibroelastosis (infantile and childhood type) as 
a distinct diagnostic entity. 

The clinical picture is repetitious and recognizable, A newborn, 
an infant, or a young child develops respiratory distress. The man- 
ifestations are frequently cough, noisy breathing, grunting expiration, 
flaring of the nostrils, and tachypnea. Frequently, the child has prev- 
iously been well. These signs of heart failure are usually initially 



14 



Medical ISIews Letter, Vol, Z6, No, 12 



attributed, to bronchial pneumonia. The child may die immediately after 
an illness of but a few days, but usually the respiratory difficulties persist 
in spite of antibiotics. Because of the persistent respiratory problem, 
an x-ray of the chest is obtained. This will indicate not only bilateral 
pulmonary congestion, but an enlarged globular heart of no specific 
contour. This is frequently the first suggestion that the heart is involved 
in the illness. Re-examination of the patient will confirm that a persistent 
tachycardia is present. The heart sounds are muffled and distant. A 
diastolic gallop rhythm is common. A murmur may or may not be heard. 
A tender large liver and peripheral edema may be found. Occasionally, 
hepatomegaly and ascites are present without edema. An occasional 
patient will have severe right-heart failure with tricuspid regurgitation 
manifested by deep systolic jugular pulse and a pulsatile liver. The 
obvious physical findings of an associated congenital lesion such as a 
coarctation of the aorta or ductus arteriosus may be present. However, 
these do not seem adequate to explain the cardiac failure. Pallor and a 
fall in blood pressure are commonly noted. , 

The electrocardiogram is usually abnormal. In addition to a sinus 
tachycardia, the most frequent change is in the T waves with depression, 
flattening, and sometimes inversion. These changes are nonspecific. 
The RS-T segment is frequently depressed. P-R interval prolongation 
and slight widening of the QRS complex are common. Tall peaked P waves 
suggest auricular involvement. In general, the findings are nonspecific 
and in keeping with the diagnosis of subendocardial or myocardial ischemia 
and auricular dysfunction. 

The progress of the disease is unpredictable, but generally down- 
hill. Digitalization, sodium restriction, and mercurial diuretics fre- 
quently control the cardiac failure. However, the cardiomegaly persists 
and eventually cardiac failure and death occur. An occasional child 
expires in shock with pallor, cold, damp extremities, and hypotension. 
Moderate cyanosis is not uncommon. 

A fair state of compensation with therapy and restricted activity 
occurs in a few children for as long as two or three years. It is possible 
that a similar endocardial lesion seen in adults simply represents quies- 
cent or latent disease from childhood. However, the uniformity of the . 
pattern of the childhood picture and the relative disappearance of the 
disease during the second, third, and fourth decade are arguments 
against this. The disease must be differentiated from bronchial pneu- 
monia, rheumatic carditis, acute myocarditis, Fiedlers myocarditis, 
paroxysmal auricular tachycardia of infancy and glycogen storage disease, 
(Dimond, E.G., Allen, F. , Moriarity, L. R., The Clinical Picture of 
Endocardial Fibroelastosis - Infant and Childhood Type: Am. Heart J. , 
50: 651-654, November 1955) 



Medical News Letter, Vol, 26, No. IZ 



) 

15 



T uberculosis Relapse Factors 

The present study was undertaken to evaluate statistically the effects 
on relapse of various factors which might influence the outcome of pulmon- 
ary tuberculosis. The factors included were sex, extent of disease, age, 
condition on discharge, baeteriologic and roentgenograpMc data, regimens 
of chemotherapy, and types of other treatment. It is important to deter- 
mine the various factors related to relapse in order to minimize the 
frequence of reactivations. 

The present study is concerned with a selected group of patients with 
pulmonary tuberculosis who were discharged from Glen Lake Sanatorium 
during the period from January 1, 1948, through December 31, 1953. 
Follow-up information included data up to November 30, 1954, 

The inclusion of relapse data for patients who received chemotherapy 
alone or with excisional therapy and the duration of the follow-up observa- 
tions make the present report different from earlier studies. Great effort 
was made to analyze the material with the aid of appropriate statistical 
techniques. 

The factors of relapse in pulmonary tuberculosis are so complicated 
that ofte factor may be analyzed alone without finding any apparent associa- 
tion with the rate of reactivation, but if combined with another factor it may 
be found to have a significant correlation with the incidence of relapse. In 
the present study, "this has been shown in the case of "strict" bed rest 
when associated with other forms bf treatment and chemotherapy when used 
with other forms of therapy. 

Analysis in the present study revealed that the post-treatment relapse 
rate for pulmonary tuberculosis was definitely higher in males than in 
females. If the age was also taken into account, however, it was found 
that there were no important differences in relapse rates for the two sexes 
in certain age groups, namely 10 to 29 years, and in patients more than 
70 years of age. Patients in the older age groups had a greater propensity 
to relapse. 

Two possible explanations for this finding in the present study deserve 
comment. The older age groups had less adequate total treatment during 
the acute phases of tuberculosis and this was also probably true in the pre- 
chemotherapy and pre-resection era. Furthermore, their age would often 
make re sectional surgery unfeasible. More attention should be paid to the 
older age group whose so-called "latent" tuberculosis has a great poten- 
tiality for progression. 

On the present hospital service, streptomycin was used alone until 
1950. At that time, streptomycin-PAS was used in a few patients, but the 
majority still received streptomycin alone (1 gm. daily) for leas than 3 
months. Long-term regimens (more than one year), consisting pf strepto- 
mycin (1 gm. twice weekly) with PAS (12 gm. daily) were initiated in 1952. 



16 



Medical News Letter, Vol. 26, No. 12 



At about the same time, the use of isoniazid (300 mg, daily) was instituted 
either alone or along with streptomycin. 

The patients who were on regimens of streptomycin alone or with 
PAS for 3 months or less were observed from 3 to 6 years. The patients 
who received isoniazid alone, isoniazid- streptomycin, or streptomycin- 
PAS for prolonged periods were observed from 11 months to 2 years. 
Why appai'ently significant differences were found among regimens of 
chemotherapy combined with other treatments, but not among the regimens 
when used alone, cannot yet be answered. 

The type of treatment appeared to influence significantly the incidence 
of reactivation. It was evident throughout this study that prolonged chemo- 
therapy for one year or more was remarkably effective as was lung resec- 
tion combined with chemotherapy. Resectional surgery plus chemotherapy 
demonstrated superiority over chemotherapy alone in patients with far 
advanced tuberculosis but this was not found to be true in patients with 
moderately advanced tuberculosis. The cumulative incidence of relapse 
during the period of observation following discharge was 28. 5%. 

Significant relationships were demonstrated between incidence of 
relapse and the following factors: sex, extent of disease, unilateral and 
bilateral lesions, age, circumstances surrounding hospital discharge, 
condition on discharge, bacteriologic findings on admission, bacteriologic 
findings on discharge, presence or absence of cavity on admission and dis- 
charge, duration of "strict" bed rest combined with other treatments, 
regimens of chemotherapy combined with other treatments, length of 
chemotherapy, and type of treatment. 

There were no significant correlations between the incidence of 
relapse and the following: (1) right or left pulmonary lesions am.ong uni- 
lateral cases, (2) duration of disease, (3) length of hospitalization, (4) 
duration of "bed rest" alone, and (5) the particular regimens of chemo- 
therapy when used alone, {Oyama, T. , Factors Influencing Relapse in 
Pulmonary Tuberculosis; Am. Rev. Tuberc. , 72: 613-629, November 
1955) 

i 

Surgery of Blood Vessel Grafts 

In general, there are five main indications for re-establishing the 
arterial continmty of the aorta and the major arteries: (1) obliterative 
diseases of the aorta and the major arteries of the body; (2) aneurysms 
of the aorta and major arteries; (3) injuries which have resulted in inter- 
ruption of arterial continuity secondary to thrombosis or division of an 
, artery; (4) tumors situated near major arteries in which it is necessary 



Medical Ne-ws Letter, Vol. 26, No. 12 



17 



to resect these blood vessels in order to perform an adequate "cancer 
operation;" and (5) congenital vascular lesions. 

The most common use of blood vessel grafts is in the treatment of 
obliterative arterial diseases involving the aorta and the arteries of, and 
those which supply, the lower extremities, secondary to atherosclerosis. 
The chief reason to re-establish arterial continuity in'the majority of these 
patients is to restore the muscular function of the limb by improving the 
arterial blood supply to it. Intermittent claudication, the most common 
symptom in these patients, develops because of an inadequate arterial 
blood supply to the muscles of the lower leg, thigh, or buttocks during 
muscular exercise, the result of arterial obliteration in the major arteries 
to the involved limb. 

The arteries most commonly affected by the obliterative process, 
which can be treated by vascular grafts, are the abdominal aorta distal to 
the renal arteries, the iliac s, the fenioral, and the proximal portion of 
the popliteal artery. In the case of smaller arteries, such as the posterior 
tibial, anterior tibial, and peroneal arteries, the lumen of which are so 
small in the diseased state that vascular anastomosis can rarely be accom- 
plished. 

One of the most important indications for the use of blood vessel 
grafts is in the treatment of abdominal arteriosclerotic aortic aneurysms, 
because of the inevitability of death resulting from rupture of the aneurysmal 
sac. It is believed that the presence of an abdominal aortic aneurysm, 
whether it is giving symptoms or not^ — but especially if it is— -is sufficient 
indication to warrant resection of it with replacement of the aorta and its 
major bifurcation with an aortic graft. In addition, the insertion of a 
blood vessel graft to restore the arterial continuity after the resection 
of an aneurysm of the iliac, femoral, and popliteal arteries is the best 
form of treatment of these lesions. Excision of aneurysms involving these 
blood vessels is performed chiefly to prevent rupture of the aneurysmal 
sac, but also, in addition, to relieve pain and to prevent embolization of 
the arteries distal to the aneurysm from the dislodgment of an intrasac- 
cular thrombus. The results of this method of treatment in this type of 
lesion have been especially gratifying because the threat of death from 
rupture of the aneurysm has been removed and at the same time normal 
arterial circulation is restored to the parts distal to the Bite of the aneur- 
ysm. The use of arterial homografts is also of great value to re-establish 
arterial continuity after removal of aneurysms involving other major 
arteries, including the iliac, femoral, popliteal, subclavian, and carotid 
arteries. 

The value of vascular grafts in the treatment of major arterial 
injuries secondary to high velocity missiles was clearly demonstrated 
by Jahnke and Seeley and others in reports from the United States Army 
Medical Department during the Korean conflict. 



18 Medical News Letter, Vol, 26, No. 12 

The operability and, undoubtedly, in some cases the curability of 
malignant lesions that involve major arteries, especially in the neck and 
limbs, can be greatly extended and improved by utilizing vascular grafts 
because much wider excisions of the growths with greater margins of 
safety will be possible if the involved artery is resected with the tumor 
and the arterial continuity restored with a graft, thereby preserving the 
part distal to the tumor. 

Another important use of vascular grafts is in the treatment of con- 
genital arterial lesions. They are of special value in the infantile type of 
coarctation of the aorta where the narrowed portion is so long that res- 
toration of the aortic continuity is impossible without the insertion of 
some type of graft. 

For practical purposes, three types of blood vessel grafts are 
available to restore arterial continuity: {1) autogenous venous; (2}\homo- 
logous venous; and (3) homologous arterial. A fourth type of graft is a 
tubular prosthesis made from one of several synthetic fabrics including 
Vinyon-N, nylon, Orion, and Dacron, 

The utilization of homologous blood vessel grafts has necessitated 
the development of some method for preserving blood vessels. At the 
present time, four methods are available: (1) nutrient broth, (2) 
quick-freeze; (3) freeze-dry; and (4)f frozen-irradiated. 

It is believed that the use of homologous arterial grafts is a method 
of treating aortic and major arterial lesions which supplants all others 
in many patients. It is a feasible procedure today because of: better 
surgical equipment and suture material; the availability of the anticoagu- 
lant heparin to prevent the clotting of the blood during the operative pro- 
cedure , and the antibiotics to prevent infection; improved anesthesia 
techniques including the catheter spinal type of anesthesia which has been 
most commonly used; and better preoperative and postoperative c'are of 
these critically ill patients; and perhaps most important of ail is the fact 
that artificial homografts are now available'in the blood vessel bank for 
the perforinanGe of these highly technical procedures. The end-to -side 
type of vascular anastomosis has made it possible to extend the homo- 
grafting procedures to include cases that could not possibly be accom- 
plished with the end-to-end method. The chief contraindications to this 
type of surgery are (1) severe coronary disease which would make these 
long operative procedures too dangerous to perform; (2) extensive oblit- 
erative arterial disease involving the aorta and the major arteries so 
that the grafts can not be anastomosed satisfactorily to the host arteries; 
and {3) obliteration of the popliteal artery and its terminal branches. 
(Linton, R, R, , Some Practical Considerations in the Surgery of Blood 
Vessel Grafts: Surgery, 38:817-833, November 1955) 



Medical News Letter, Vol. 26, No. 12 



19 



Disaster Relief Planning 

Information obtained from two operations of an emergency nature 
involving disaster relief planning during the past year has revealed the 
urgent need for adequate planning for exigencies of this nature. Had 
adequate passive defense plans been formulated and effected, much delay 
and confusion resulting from sudden calls to participate in such operations i 
would have been avoided. This discussion is not intended to detract from 
the meritorious efforts of the Units participating in any discussed opera- 
tions. In fact, the Surgeon General has indicated his warmest personal 
satisfaction at the noteworthy achievement of all personnel who partici- 
pated. Instead, however, it is intended to direct active planning at all 
levels to the development of, and exercises in, passive defense or disaster 
plans. 

One example occurred during the Operation "Passage to Freedom" 
involving the evacuation of over 300,000 refugees from the Haiphong Area 
of French-Indo China. This operation was set in motion and actually 
started within less than two days from the first receipt of notice that this 
was to be a naval operation. A naval m^edical task group was orgnanized 
in less than 24 hours and was on board ship and underway. However, the 
equipment, medicines, and additional personnel necessary for fulfillment 
of the mission had.to be ordered by dispatch from the ship enroute to the 
operation. 

Considerable confusion and delay (not to mention lost tempers, etc. ) 
resulted from this procedure. Over two weeks time was lost before the 
equipment was received by the Medical Task Unit. Some of the equipment, 
specially ordered and purchased on the open market was shipped to the 
Task Group, but was never received by the group. The sad part of the 
story is this: The equipment, ordered because it was vital to the mission, 
actually arrived in the area of operations in less than three weeks, but 
the group was not aware of its procurement and arrival until some time 
after members of the Task Group concerned with its operation had been 
phased out and had returned to their permanent duty stations and the 
equipment had returned to its initial starting point. Other equipment 
that was "begged, borrowed, or stolen" from other units of the Navy, the 
Marine Corps, or the Army arrived in two or three weeks, but again, 
several days delay were necessitated in its use because the personnel who 
were to operate this equipment had to learn how to use it first, and had to 
procure necessary chemicals from local sources — again, no simple task^ 

Another example of the need for disaster or passive defense planning 
occurred during the Tampico floods in Mexico and the relief to the city of 
Corozal, British Honduras, following hur ricane Janet. There was a 
Preventive Medicine Unit standing by to assist in the relief operations 



20 



Medical News Letter, Vol. 26, No. 12 



whose members have been constantly trained for such operations, but it 
was never called in, although the Officer in Charge was called in for tNwo 
days twelve days after the disaster occtirred. 

Fortunately, a medical task group was rapidly organized under the 
District Medical Officer of the 15th Naval District. This Task Group 
performed superior service and received high praise from United States 
and Mexican authorities. Again, however, all equipment, medicines, 
and personnel had to be procured from different sources and transported 
to the area with time losses which could have been avoided had a proper 
plan been previously developed and put into operation. 

A Chief Warrant Officer of the Hospital Corps, for example, obvious- 
ly had made previous disaster plans, as this quotation from his letter 
indicates. The quotation also indicates some of the conditions encountered: 

"It seems weeks ago since I was sent over from Guantanomo Bay to 
assist British Honduras in the Corozal area following hurricane Janet. 
It has been an experience, to say the least. The hurricane hit in what 
is known aa the "back country" with the largest town being the city of 
Corozal, population 3986. Eleven persons were killed and eighty or 
more were injured. I have seen hurricanes before, but never one which 
did as much damage. Concrete buildings were flattened and the town was 
a complete wreck. How so many escaped injury, we will never know or 
understand. 

I brought a lOO-gallon tank Buffalo Turbine, a Model 303 Microsol, 
and a barrel-top sprayer along with all the insecticide concentrates 
we could spare, plus paradichlorobenaene and HTH (70% hypochlorite). 
Flies were reported to be resistant to DDT and to Dieldrin, but chlor- 
dane did an effective job. We treated for fly control some 36 villages and 
the city of Corozal. Both the Turbine and the Microsol did excellent 
work. I brought my Jeep as a tow vehicle. The British Honduras pro- 
vided their senior Sanitary Inspector. We lived in the bush for a few 
days, then set up headquarters in Orange Walk and operated from there. 
As epidemic control measures, we chlorinated all water supplies, set 
up a paradichlorobenzene-in-privy program, and killed as many flies 
as we could. The Province Director of Health seems pleased. 

It was hard work and I'm sure there is not one inch of skin on my 
body that has not provided a meal for several mosquitoes. Their "Taenys" 
are about twice the size of ours {therefore, twice as hungry), with A. 
albimanus by the millions. I am sitting in a boarding house in Belize 
waiting for an air lift for my equipment and myself to Tampico. I only 
hope their flies are not DDT resistant, as that is all the insecticide we 
have left. " 



Medical News Letter, Vol. 26, No. 12 



21 



The following extracts are from a report by a Captain in the Med- 
ical Corps, quoted to further sunamarize the services rendered by person- 
nel of the Navy Medical Department in the Tampico area and to indicate 
some of the factors to be considered in disaster planning: 

'*a. Background information. It is estimated that an area of more 
than 300 square miles was inundated. Some 60, 000 people in the Tam- 
pico area were driven from their homes by the flood waters. Waters 
receded quickly in the upper regions of the flooded area and roads were 
open to inland sources of food, medical supplies, etc. A "wide area, 
however, was still inundated and would remain so for 7-10 days more. 

Conferences with local physicians and health authorities revealed 
that endemic diseases present included typhoid fever, amebic dysentery, 
bacillary dysentery, and malaria. It was stated that 90% of the popula- 
tion was immune to smallpox by means of vaccination. Typhoid inocula- 
tions were reported to have been maintained fairly well. The malaria 
control program consisted of DDT residual spraying of buildings and 
the application of plain oil as a larvacide. The staff and equipment 
were considered adequate for normal situations. 

b. Navy participation. On 1 October 1955, CDH E, C. Sweeny 
MC USN, the Senior Medical Officer of Task Group 84. 7, and eleven 
other Navy medical officers and twenty-three corpsraen arrived. In 
conference with local health authorities, a joint program was planned 
which was inaugurated on 2 October. The local practicing physicians 
were gradually assuming more and more of the load of medical care. 
They participated in all phases of the work. 

Mexican and U. S. Navy Medical Teams were flown by American 
helicopters to the marooned villages where routine medical care and 
typhoid immunizations were provided. Similar services were rendered 
in Tampico. After the typhoid inoculations were completed in Tampico, 
DPT (Diphtheria -Pertussis -Tetanus) immtuiizations were started for 
children between the ages of 2 months and 15 years. In addition, med- 
ical teams went from house to house in an effort to immunize a higher 
percentage of the local populace. 

Early insect control was considered important; so the CWO HG 
from Guantanamo Bay, Cuba, was brought into the Tampico area. 
On Sunday, 10 October, a Lieutenant Commander, MSG, was flown 
from Corpus Christi for a quick estimate of the situation and returned 
on 12 October with insecticides, equipment, and 2 HMC, ESTs. All 
were made available to local authorities. In addition, offers of air- 
craft dispersal of insecticides by Navy planes from Corpus Christi 
were made to federal and local authorities. 



22 Medical News Letter, Vol. 26, No. 12 



The U.S. Marine Corps brought ten portable water purifica- 
tion units to Tampico, whose mxmicipal water aystein was inoperative; 
however, because an adjacent petroleum company had its water plant 
in full operation, only four water purification units were set up. 

c. Health conditions. Local physicians stated that respiratory 
diseases (colds and broncho -pneumonia) and mild diarrheas were the 
only conditions above normal numbers. Three or four cases of sus- 
pected typhoid and some malaria were reported. Fungus infections 
and superimposed bacterial infection of the feet were common. 

d. Housing and Sanitary Facilities. The displaced group was 
estimated by the Task Group personnel to number 60, 000, with marked 
overcrowding, poor sanitation, inadequate clothing and bedding. Large 
quantities of clothing were available and were being distributed. 

e. Conclusions. It is felt, however, that operational plans for 
similar disaster relief work should contain preventive medicine elements 
in the first echelon to insure complete preventive medicine coverage. 
This recommendation is intended in no manner to imply deficiencies in 
the Tampico Operation. Such provision, however, undoubtedly will 
prove to be of assistance to senior medical officers in similar situations. 

Following is a tabulation of medical supplies available and/or 
expended, and medical services rendered October 2-13, 1955, inclusive: 

Medical Supplies 

Weight provided by Mexican sources 1000 lbs. 

Weight provided by U. S. S. Saipan 6695 lbs! 
Amount expended (wt. ) 

by six local Mexican Hospitals 2800 lbs. 

by Navy and Mexican Medical teams 3246 lbs. 

Helicopter Medical Missions 114 
(of 72 Missions through October 8, 33 were by 
Navy Medical Officers and 40 by Mexican 
Physicians) 

Routine Medical Care 

Total number treated in outlying villages 4577 
Total number treated in Tampico (by Navy) 1146 

Immunizations 

by Mexican Physicians in Tampico 40, 000 

by Navy personnel in Tampico 10, 000 
Total in outlying areas g03 

Total 50, 903" 



I' 



Medical News Letter, Vol. 26, No. 12 



23 



As is customary in such cases, hindsight is much greater than fore- 
sight. But need it be so? Current instructions, and instructions in the 
process of being released, call for development of passive defense or 
disaster plans. These plans should include provisions for disaster relief 
formulated on a basis wherein mutual medical assistance for adjacent in- 
stallations is a prime consideration; hence, should a disaster occur, the 
groundwork will have been laidr mobile teams will have been established 
and trained as a unit; essential supplies and equipment will have been 
obtained or located; personnel will be conversant with their equipment; 
and then the disaster unit is ready to roll— whether the disaster be man- 
made or a product of nature, 

A most important point that should be kept in mind whenever a 
disaster strikes is that the Preventive Medicine Units have been estab- 
lished for the prime purpose of aiding in preventive medicine problems. 
Their continued training programs and organizations have been developed 
for such emergencies and should be so utilized. It is suggested, therefore, 
that each responsible member of the Navy Medical Department acquaint 
himself with the services offered by the Preventive Medicine Units, because, 
who knows, it may be your turn next! {PrevMedDiv, BuMed) 

****** 
T rainin g and Assignments In Diving Medicine 

Current medical officer billet allocations include four naval activities 
to which are assigned medical officers who have previously been trained 
in the medical aspects of diving and underwater swimming. Such activities 
are the Naval School, Salvage, Bayonne, N. J. , the Naval School, Under- 
water Swimmers, Naval Station, Key West, Fla. , and the two underwater 
demolition organizations under ComPhibLant and ComPhibPac at Little 
Creek, Va. , and Coronado, Calif. , respectively. 

Applications are desired from Regular and Reserve medical officers 
of the rank of Lieutenant Commander and below for the next course of 
instruction in diving medicine. Such course is of approximately 2 months' 
duration and will commence on or about 5 March 1956, at the Naval School, 
Deep Sea Diving, Naval Gun Factory, Washington, D. C. No service 
agreement is required for this training; however, at least one year of the 
current service obligation must remain after graduation from the course. 
Billet vacancies are expected to occur next spring at the Naval School, 
Salvage, Bayonne, and Underwater Demolition Unit #1, U.S. Naval, 
Amphibious Base, Coronado, Calif. 

Applicants must be physically qualified in accordance with Article 
15-30, Manual of the Medical Department and a completed SF 88 should 
accompany the application. 



24 



Medical News Letter, Vol. 26, No. 12 



It should be noted that the above training is considerably shorter 
than the 6-month course currently prescribed for Submarine Medical 
Officers. The latter course includes an additional 4 months' training at 
the U.S. Naval Submarine Base, New London, Conn. , requires a service 
agreement, qualifies the medical officer for duty with all submarine and 
diving activities, and fulfills the basic requirement toward qualification 
to wear the submarine medical insignia (Art. C-7309, BuPers Manual). 

Applications should be forwarded to the Chief of the Bureau of 
Medicine and Surgery with completed SF 88 as its enclosure. (SubMedDiv, 
BuMed) 

jji jjC 5^ ?{t jjc 

"A Letter " 

The following letter was received from Doctor J. Wyllie, Professor of 
Preventive Medicine, Queen's University, Kingston, Ontario. 

"I am indebted to you for your kindness in favouring me with issues 
of the U. S. Navy Medical News Letter. I find some very interesting 
material in these publications and make extracts from them for teach- 
ing purposes. 

In the issue for 4 November 1955, I was interested to read about 
the program for 'Influenza Vaccination' and the summary on the 
'Effectiveness of Polio Vaccine. ' I am enclosing a form duly filled 
up and trust you will continue your service during next year. Also, 
in this issue, I note on page 37 the water supplied to commercial 
concerns manufacturing ice should meet certain bacteriological and 
chemical standards as set forth for drinking water in the 'Preventive 
Medicine Laboratory Methods Manual. ' 

I wonder whether you could favour me with a copy of this Manual, 
as I am sure I would find in it some interesting la.boratory methods 
which would be useful for teaching purposes. I shall be grateful if 
you can arrange to do this for me. " 

Change of Add ress 

Please forward requests for change of address for the News Letter to: 
Commanding Officer, U.S. Naval Medical School, National Naval Medical 
Center, Bethesda 14, Md. , giving full name, rank, corps, and old and new 
addresses. 



Medical News Letter, Vol, 26, No. 12 



25 



From the Note Book 

1. Rear Admiral B. W. Hogan, MC USN, Surgeon General of the Navy, 
attended the meeting of the Association for Research in Nervous and 
Mental Diseases, held in New York City, December 9, 1955, (TIO, BuMed) 

2. Rear Admiral B, E. Bradley, MC USN, Deputy Surgeon General, and 
Assistant Chief of the Bureau of Medicine and Surgery, accompanied 
Doctor F. B. Berry, Assistant Secretary of Defense (Health and Medical), 
and his Civilian Health and Medical Advisory Council, on a visit to Med- 
ical Department activities in military installations in the Caribbean area 
and Florida. The group visited Bermuda; the Panama Canal Zone; Guan- 
tanamo Bay, Cuba; Puerto Rico; and Key West, Jacksonville, and Pensacola, 
Fla. {TIO, BuMed) 

3. Rear Admiral C. F. Behrens, MC USN, represented the Commandant, 
Sixth Naval District, at the Seventh Annual Nuclear Sciences Seminar, 
held at Oak Ridge, Tenn, , November 28, 1955, Admiral Behrens, Sixth 
Naval District Medical Officer, addressed the Seminar, The subject of his 
address was "A Few Medical Highlights. " (DMO, 5th ND) 

4. At the recent Annual Meeting of the Fellows of the American College of 
Surgeons, Rear Admiral T, F. Cooper, MC USN, Inspector General, Med- 
ical Department Activities, was elected member of the Board of Governors 
to represent the U.S. Navy Medical Corps. (TIG, BuMed) 

5. The Navy Department has announced the selection of four inactive 
Naval Reserve Captains of the Medical Corps for promotion to the grade 

of Rear Admiral, MC USNR. The officers selected were: Captain Waltman 
Walters, Mayo Clinic, Rochester, Minn, , Captain Morton J. Tendler, 
Memphis, Tenn, , Capt^^in William G, Hamm, Atlanta, Ga. , and Captain 
Benjamin Tenney, Jr. , Boston University School of Medicine, Boston, 
Mass. (TIO, BuMed) 

6. Captain H. C. Oard, MC USN, represented the Bureau of Medicine 
and Surgery at the Third American Congress of Industrial Medicine, held 
in Caracals, Venezuela. (TIO, BuMed) 

7. Retirement Points Authorized for Certain Types of Reserve Trai ning - 
The Dental Officer Mass Casualty Treatment Training Program covers the 
following subjects: 

a. Dentistry - an aid in disaster c. Psychological first aid 

b. Battle dressing station duty d. Field anesthesia 



26 



Medical News Letter, Vol. 26, No. 12 



e. 


Head and neck wounds 


1. 


Burns 


f. 


Chest wounds 


m. 


Shock 


g. 


Abdominal wounds 


n. 


Parenteral therapy 


h. 


Control of hemorrhage 


o. 


Medicament 


i. 


Fractures 


p. 


Dressings, bandages, splints 


j. 


C ric othyroidotorn y 


q. 


Transportation 


k. 


Resuscitation 


r. 


Radiation injury 



At the request of the Bureau of Medicine and Surgery, the Chief 
of Bureau Personnel has authorized one retirement point credit for each 
session of not less than two hours on any of the above subjects. This 
training may be in connection with any military or civilian dental organ- 
ization, but must be given by Armed Forces Personnel. (DentDiv, BuMed) 



8. What is believed to be a Navy "first" occurred recently when Rear 
Admiral Wendell G, Switzer, USN, relieved Rear Admiral M. E. Murphy, 
USN, as Commander Naval Forces Marianas in a change of command 
ceremony at the Naval Hospital in Guam. This is believed to be the first 
time that a ceremony for a change of line command has been held in a 
naval hospital. (TIO, BuMed) 

9. More than 52 million people in communities of 25, 000 and over now 
depend upon surface sources for their daily water supplies, as compared 
with fewer than 40 million eight years ago. The use of untreated water by 
the country's larger communities has virtually ended. Less than one percent 
of the population in communities of 25, 000 and over today use untreated 
water. (PHS, HEW) 

10. "Follicular Lymphoma: A Re -Evaluation of Its Position in the Scheme 
of Malignant Lymphoma, Based on a Survey of 253 Cases, " by Henry* 
Rappaport, M. D. . William J. Winter, M. D. , and Ethel B. Hicks, will 
be published in a forthcoming issue of the Journal, Cancer . This study 
comprised of a larger number of cases of this condition than has previously 
been reported in medical literature, presents a number of distinct cytologic 
variations in the neoplastic follicles which have led the authors to propose 

a new concept, integrating the types of this lymphoma into the general 
cytologic classification of malignant lymphomas. (AFIP) 

11. Abscess of the prostate should be suspected in patients, particularly 
diabetics who have inflammatory diseases of the lower geni to -urinary • 
tract, when the disease is accompanied by severe perineorectal pain. 
Diagnosis and definitive therapy should not await the development of local 
fluctuation. (Surg. Gynec. & Obst. , November 1955; L. Persky, M. D. , 
et al. ) 



Medical News Letter^ Vol. 26, No. 12 



27 



12. Seven cases of leukemia and one case of lyropho sarcoma and preg- 
nancy are reported. There was no exacerbation of the leukemic process 
during pregnancy in these patients, and no evidence of leukemia was noted 
in the children. (Am, J, Obst. & Gynec. , November 1955; D. L. Gillim, M. D. ) 

13. A cobalt-60 revolution therapy unit is described. The unit was designed 
to hold a source of 1750 curies, although it can accommodate a source of 
twice that strength. The source shield revolves either completely or in 
sectors about a recumbent patient. The shield itself can be angulated. 

The distance from the source to the center of revolution is fixed at 81, 6 cm. 
The treatment cot is aligned by means of one rotational and 3 linear motions. 
Rectangular and square field shapes of arbitrary size up to 15 x 15 cm. 
are available. (Am. J. Roentgenol., November 1955; L.H. JLanz, PhD., 
D, D. Davison, M.S., and W. J. Raine) 

14. Hydrodextran adequately fulfills the accepted criteria for a synthetic 
volume expander and offers several advantages as compared to blood. 
(Ann. Surg., November 1955; J. H. Harrison, M. D. , W. F. Burden, M, D. , 
A. S, Kellum, M. D. ) 

15. The Modern Surgical Treatment of Renal Tuberculosis is discussed in 
J. Internat. Coll. Surgeons, November 1955; R. Gutierrez, M. D. 

* * * * *r * 

BUMED NOTICE 6310 22 November 1955 

From: Chief, Bureau of Medicine and Surgery 

To: All Ships and Stations Having Medical Personnel Regularly 
Assigned 

Subj: CH-5 to BuMed Instruction 6310.3, Subj: Instructions and 
Definitions Relating to CertainDiagnostic Titles, Individual 
Statistical Report of Patient, and Morbidity Report 

End: (1) P. 23 and rev. p. 24 of end. (1) to BuMedlnst 6310. 3 

This notice modifies instructions concerning signature block {block 11) 
of NavMed-F card by providing a revised page 24 to enclosure (1) of 
BuMed Instruction 6310. 3, and clarifies the application of the "Note" 
on the bottom of page 28. 



4: »{« ^ >t: ^ 



28 



Medical News Letter, Vol. 26, No. 12 



BUMED INSTRUCTION 5210. 2A 2 December 1955 

From: Chief, Bureau of Medicine and Surgery 
To: Activities Under Management Control of BuMed 
All One- and Two -Digit BuMed Codes 

Subj: Annual Report of Volume of Records Held and Destroyed 
{Report Symbol GSA-12) 

This instruction restates the requirements for an annual report of volume 
of records held and establishes an additional requirement for repotting vol- 
ume of records destroyed. BuMed Instruction 5210. 2 is canceled. 

^ 4c njc # jjt !if 

BUMED NOTICE 6710 2 December 1955 

From: Chief, Bureau of Medicine and Surgery 

To: All Ships and Stations Having Medical /Dental Personnel Regularly 
Assigned 

Subj: Antibiotics; extension of potency dates 

Ref: (a) Medical and Dental Materiel Bulletin (MDMB), Edition 
No. 60 of 1 Nov 1955 

This notice provides authority to extend the potency dates of certain antibiotics. 

****** 

BUMED INSTRUCTION 6710. 24 6 December 1955 

From: Chief, Bur'eau of Medicine and Surgery 
To; All Ships and Stations 

Subj: Defective Medical and Dental Material; authority for disposition of 

Ref: (a) Medical and Dental Materiel Bulletin, Edition No. 60, 1 Nov 1955 
(b) Art. 25-21, ManMedDept 

This instruction provides authority for the disposal of defective material 
listed in paragraph IV of reference (a). 

ijc 3{c <jc !jc rjc 3(C 



Medical News Letter, Vol. 26, No. 12 



29 



MEDICAL RESERVE SEmO]\ 



"AtomiG Medicine" - A New Correspondence Course 

This is the title of a new Medical Department correspondence 
course now ready for distribution to eligible regular and Reserve officers 
and enlisted personnel of the Medical Department. 

Evaluated at 24 promotion and retirement points, it consists of eight 
(8) objective question type assignments designed to acquaint and familiar- 
ize Medical Department personnel with the principles of Atomic Medicine. 
I During the past decade, the problems of dealing with radiation and 

radioactive materials have grown to major proportions and have become^ 
one of the main concerns of an increasing number of military, industrial", 
and medical personnel. Although ionizing radiations have been recognized 
and studied for more than 50 years, the atomic explosions of World War II 
marked the beginning of a new period in which atomic warfare and defense 
and peacetime use of atomic energy would influence the lives of everyone. 
This new era entails added responsibilities to the medical profession and 
fe offers new opportunities for medical research and treatments. As a resTilt, 

the field of atomic medicine has expanded rapidly, gaining vital informa- 
tion for atomic defense and contributing knowledge to other medical fields. 

The textbook, utilized as reading material for this course, is a 
complete new revision of Atomic Medicine, 2nd Edition, edited by RADM 
C. F. Behrens MC USN, and published by the Williams and Wilkins Company. 

Applications for this course should be submitted on form NavPers 992 
{with appropriate change in the "TO" line), and forwarded via appropriate 
official channels to the Commanding Officer, U.S. Naval Medical School, 
National Naval Medical Center, Bethesda 14, Md. 

Regular and Reserve personnel who have satisfactorily completed 
the previous course, Radiological Defense and Atomic Medicine, either 
the thesis or objective type, will receive additional credit for this course 
in that this is a complete revision of the former course. (NavMedSchool, 
NNMC, Bethesda, Md. ) 

9{e :{c 4: 9(: ^ 

The printing of this publication has been approved by the Director 
of the Bureau of the Budget, 16 May 1955. 




30 



Medical News Letter, Vol. 26, No. 12 



Selection Board for Promotion to Captain 
U. S. Na val Reserve, Inactive 

A selection board is tentatively scheduled to convene at the Navy 
Department, Washington, D. C. , on or about 7 February 1956, to recom- 
mend Naval Reserve officers of the Medical, Dental, and Medical Service 
Corps on .inactive duty for promotion to Captain. 

Officers eligible for consideration by this board arei those Commanders 
whose date of rank is prior to 5 November 1945. Officers who are within the 
above promotion zone should take individual action to insure that fitness 
reports for training duty, annual fitness reports, and annual qualifications 
questionnaires covering the period ending prior to the convening date are 
submitted to the Bureau of Naval Personnel in time to be included in the 
officers' records when presented to the selection board. Special fitness 
reports are not required; however, an office* applying fOr consideration 
for promotion by the selection board shall have the right to forward, through 
official channels, a written communication inviting attention to any matter 
of record concerning himself which he deems important in his consideration. 
Such cornmuiiications may iiot critieize nor reflect upon the character, con- 
duct, ot motive of any other officer. 

Individual officers should insure that officer records contained in the 
Bureau of Naval Personnel reflect correct home of record and present 
address, 

9^ jjc sfc ?^ }^ 

AVIATION MEDICINE SECTION 




Major Laboratories Associated with Aviation Medicine Problems 

A total of five major laboratories in the U. S. Navy are intimately 
concerned with aeromedical problems. For clarity, these laboratories 
are listed giving the mission and some of their major projects which are 
being pursued at this time. 



Medical News Letter, Vol, 26, No. IZ 
Aeronautical Medical Equipment Laboratory, Philadelphia, Pa. 



31 



Mission: To conduct basic and applied research in the field of 
aviation medicine with particular reference to physiological and psy- 
chological aspects of aviation visual problems, and to the principles 
of protection of personnel against the effects of high altitudes, extreme 
temperature and humidities, high linear accelerations, noxious gases, 
and ultrasonic vibrations, as may be directed by the Chief of the Bureau 
of Aeronautics; and to conduct development, engineering tests, and opera- 
tional evaluation of equipment required to maintain aviation personnel 
under these conditions. 

Major Projects - Aviation Injury and Crash Studies: 

1. Investigation into the health hazards of engine test cells. 

2. Experimental testing with an HG-1 crash catapult. 

3. Investigation of human tolerance to parachute opening shock. 

4. Biomechanics of aviation crash injuries and of protective t 
measures. 

5. Hazards due to noise generated in naval activities and of 
thethods of protection against such hazards. 

6. Omni -environmeM full pressure suit. 

7. Evaluation of aircraft crashes to obtain information needed 
in providing protection for personnel, 

8. Development and testing of full pressure, omni- environmental 
suit. 

9. Quick disconnects of oxygen equipment. 

10. Development, testing, and evaluation of oxygen systems and 
components. 

lli DevelopmeM, testing, and evaluation of anti- expo sure suits. 

12. Designing of criteria for protective helmets. 

13. Designing and testing of survival equipment and components. 

14. Fabric research. 

15. Airborne urinal bag. 

16. Development and testing of ejection systems. 
Aviation Medicine Acceleration Laboratory, Johns ville, Pa. 

Mission: To conduct research into the biological and physical effects 
of acceleration forces developed in aircraft under various operational 
situations; to conduct research in the general fields of aviation medicine, 
aviation physiology, and human engineering in respects to aviation; to 
develop, improve, and evaluate individual aircraft and equipment. 

Major Projects - Acceleration /Deceleration Studies with the Human 
Centrifuge and Research Aircraft: 



32 



Medical News Letter, Vol. 26, No. 12 



1. In-flight physiological and psychological reaction to supine position. 

2. Effects of acceleration upon the cerebral metabolism of cerebral 
, blood flow. 

3. Effects of external pres surization of the legs and abdominal 
cavity upon the cardiovascular system when applied during 
exposure to high headward acceleration. 

4. Developrnent of biological research apparatus for use in 
acceleration /dec deration studies. 

5. Human tolerance to combined acceleration. 

6. Pathological changes produced by stress of acceleration. 

7. Investigation of the effects of acceleration forces on a pilot 
during automatic interceptor attack. 

8. Observations on negative "G" developed in aerobatics. 

9. Testing and development of anti -blackout equipment. 

10. Anatomical distortions, fliiid translocation, and electrolyte 
changes in animals under acceleration stress, utilizing spectro- 
photometric radiobiologic and quick freeze techniques. 

11. Effect of increased forces of acceleration upon the blood flow 
and displacement of intra- vascular fluid. 

12. Miscellaneous tests and minor investitgations. 

Aviation Physiology Studies: 

1. Elastic properties of mammalia tissue. 

2. Transformation of biological energy resulting from oxygen 
uptake. 

3. Effect of heat and cold on living mammalia tissues. 

4. Designing and development of multipurpose aviators' suit. 

5. Testing and development of anti-blackout equipment and controls. 

6. Determination of limitations of equipment and personnel. 

7. Acceleration testing of personnel equipment. 

Na val Medical Research Institute, NNMC, Bethesda, Md . 

Mission: To implement medical and allied research for the improving 
of naval medical practice for the ptotection of personnel against injury, the 
prevention of disease, and the treatment of the ill and maimed. 

Major Projects - Aviation Physiology Studies: 

Ti Transmission of physiological responses from air to ground by 
electronic methods. 

2. Evaluation of the role of various afferent components of the 
nervous system in operation of aircraft. 

3. Analysis of observable mental and physical behaviors involved 
in the actual control of aircraft and methods for their direction: 

4. Acute biological effects of microwaves (radar). 



Medical News Letter, Vol, 26, No. 12 
Naval Air Test Center, Patuxent River, Md. 



33 



Mission : To conduct flight test trials, accelerated field service 
tests of aircraft, aeronautical equipment and components under flight 
conditions. Conduct test pilot training, provide flight support of specific 
projects for industrial and military agencies as assigned by the Bureau 
of Aeronautics. Provide technical advice and assistance to the Board of 
Inspection and Survey, and conduct such aircraft trials or portions thereof 
as may be required by that Board. 

Major Projects: 

1. Flight test and evaluation of Omni -environmental full pressure 
suit. 

2. Develop and evaluate liquid oxygen ground storage and transfer 
systems and test, stands, 

3. Flight test of airborne oxygen systems and controls^ 

4. Flight test personnel equipment. 

5. Service evaluation of protective helmets. 

6. Service evaluation of sound attenuating devices. 

7. Flight testing of integrated harness system equipment. 

8. Flight testing of cockpit air samplings in toxic gas study. 

Naval Parachute Unit, NAAS, El Centre, Calif . 

Mission : To conduct research development, testing, and evaluation 
of parachutes and related assemblies, pilot escape methods and systems, 
retardation and recovery systems and rescue, survival and personnel 
safety equipment as directed by the Chief of the Bureau of Aeronautics. 

Major Projects: 

1. Jump testing parachutes , harnesses, and pressure suits. 

2. Jump testing survival equipment. 

3. Integration of equipment with harness, 

4. Testing of components of pilot escape capsules. 

5. Determination of forces developed in parachute assemblies. 

6. Improvement of parachutes. 

7. Testing and development of automatic opening devices. 

8. Testing protective helmets in jumps. 

9. Testing and improvement of canopy releases. 

10. Testing and improvement of parachute assemblies for drop- 
pable survival equipment, 

11, Testing and- development of high altitude emergency chute system 



34 



Medical News Letter, Vol. 26, Mo. 12 



Har dheaded Use of the Hardhat 

The following is taken frofn a receat Medical Officers Report of aft Air- 
craft Accident: 

"The pilot was flying a night carrier hop. He received two wave-offs 
for being too high and received a cut on his third pass. He took a 
late cut and floated down the deck, apparently never touching the deck 
until his landing gear struts engaged the barrier. The aircraft flipped 
over on its back and it was several minutes before the pilot could be 
extricated. He received fatal injuries. 

The pilot did not report aboard the ship until approximately 0430 on 
the morning of the crash. He was out of bed by 0730 and was seen in 
the ready room at O^OO, giving him only 3 hours sleep on the jiight 
before the crash. He had lectures all morning and flew one afternoon 
hop, and it is believed by the squadron that he did not get any sleep 
during the day. 

Examination of the wreckage showed the following facts: 

1. The pilot's helmet was resting on the flight deck, midway between 
the cockpit and the tail when the wreckage came to rest. 

2. The gunsight was broken off and resting on the deck immediately 
beneath the cockpit, 

3. The gunsight had several red spots on it which showed a positive 
chemical test for blood. 

4. The inertia reel locking handle was in the ujilocked position . , . 

Examination of the pilot's helmet showed the following facts: 

1. The H-4 helmet outer protective liner was unscratched and in one 
piece; it was completely undamaged. 

2. No inner liner was being used by the pilot. He had cemented a 
ring of sponge rubber to the sides of the outer shell, and in the 
cavity placed the earphones and kapok liners from the inner 
liner. He had removed the leather strips containing the 02 ma^fe 
snaps from an inner liner and bolted them in place on the anterior 
edges of the outer shell, using two small stove bolts on either 
side, 

3. The only chinstrap on the helmet was a strip of elastic from a 
pair of goggles, which had snap fasteners on both ends. The 
snap on one end had pulled completely out, making it impossible 
to fasten the strap. 



iliiiiajitlilftattlthiiii 



Medical News Letter, Vol. 26, No. 12 



35 



It is apparent that the following sequence of events took place. The 
pilot was making high approaches, not using his radio altimeter. The 
plane hit the barrier and flipped over on its back. The helmet came 
off as the aircraft became inverted, thus depriving the pilot of what- 
ever protection his personalized helmet might have given him. With 
the shoulder harness unlocked, the impact caused the pilot to ram his 
unprotected head either into the deck, or into the gunsight, or both, 
causing his fatal injuries ..... 

Recommendations (by the reporting fligh t surgeon): 

1. That the appropriate officer of each squadron hold a periodic inspec- 
tion of all pilots in their flight gear. In this way, the pilot can find what 
discrepancies are present in his gear and get them corrected before 
trouble develops. Also, it gives the squadron a chance to see if any 
modifications have been made to the standard issue flight ge^r and to 
correct these discrepancies. 

2. _ That the importance of checking the shoulder harness lock as a 
routine part of the landing check-off list be re-emphasized frequently, 
especially in night carrier squadrons. " 

( Editor's Note: Have you taken a look at the protective gear being worn 
by pilots in your squadron recently? Any hardheads around who need con- 
vincing? Perhaps the above account will serve to set them straight. ) 



sjfi j(s J^C s{fi ^ 



Historical Facts of Interest for November and December 



November 1 
1920 



U. S. international passenger service was started by 
Aeromarine West Indies Airways between Key West, 
Fla, , and Havana, Cuba. 



November 3 
1909 



Lt. George C. Sweet, USN, was taken as a passenger in 
the first Army Wright airplane, thus becoming the first 
Naval officer to fly in an airplane. 



November 4 
1911 



The first flight of the new transatlantic airship Akron, 
designed by Melvin Vanniman, took place at Atlantic 
City, N. J. 



November 5 
1921 



Bert Acosta in a Curtiss Navy C12, Curtiss 400, won the 
Pulitzer Race at 176. 7 ipph at the Omaha, Neb. , air meet. 



36 ^ Medical News Letter, Vol. 26, No. 12 

November 6 ' 

1915 The first airplane catapult launching from a moving vessel 
was made by CDR Henry C. Mustin, USN, from the USS 
N orth Carolina , Pensacola Bay, Fla. 

1945 The first jet propelled landing on an aircraft carrier was 

made by Ensign Jake C. West, USN, in an FR-1 Navy turbo- 
jet and conventional reciprocating engine fighter, using jet 
power to land on the carrier Wake Island. 

November 9 

1935 U.S. Navy made the first mass seaplane flight from Honolulu 
to French Frigate Shoals, flying 759 miles nonstop in 6 hours 
10 minutes, 

November 12 

1912 The second, and successful, catapult launching made by 
LiT T. G. Ellyson in a Curtiss seaplane from a float in 
the Washington Navy Yard 

1921 The first "air-to-air" refueling was made by Wesley May, 
with a five-gallon can of gasoline strapped to his back. He 
transferred from the wing of a Lincoln Standard, flown by 

^ Frank Hawks, to the wing skid of a JN4, flown by Earl S. 

Daugherty, climbed to the engine, and poured the gasoline 
into the tank. 
November 14 

1910 The first take-off from a Navy ship was made by Eugene Ely 
from a platform built on the deck of the USS Birmingham , 
anchored at Hampton Roads, Va, 
November 16 

1927 The Navy aircraft carrier Saratoga was commissioned. 
November 21 

1917 The Navy's robot bomber {a flying bomb) was demonstrated 
to Army, Navy, and civilian aviation experts at Amityville, 
N. Y. 

1933 LTCDR Thomas G. W, Settle, USN, and Major Chester L. 
Fordney, USMC, set a balloon altitude record of 61,237 
feet over Akron, Ohio, 
November 22 

1949 The Navy announced that its D-558-2 Skyrocket had repeatedly 
exceeded the speed of sound at Muroc, Calif, 
November 29 

1929 CDR Richard E. Byrd, in a tri -motor Ford piloted by Bernt 
Balchen, made the first flight over the South Pole. 

December 1 

1949 The Navy supersonic windtunnel, capable of 3000 mph 
speeds, was dedicated at MIT. 



Medical News Letter, Vol. 26, No. 12 



37 



December 2 

1943 U.S. Navy announced acceptance for the Naval Transport 
Service of the world's largest flying boat, th*e 70-ton 
Martin Mars. 
December 10 

1943 Secretary of the Navy, Frank Knox, disclosed that the 

flying boat Mars, recently delivered, had flown 8972 miles 
on a round trip from the United States to Natal, Brazil. It 
set records for weight of cargo (35, 000 pounds) and for the 
longest overwater trip — 4375 miles from Patuxent, Md. , 
to Natal. 
December 29 

1948 Defense Secretary Forrestal announced that the United 

States is working on an "earth satellite vehicle program, " 
a project to study the operation of guided rockets beyond 
the earth's pull of gravity, 

3^ Sfs 5jc 3^ "flfi 

Course in Aviation Medicine 



The Bureau of Medicine and Surgery announces that a class in 
Aviation Medicine will convene at the U.S. Naval School of Aviation, 
Naval Air Station, Pensacola, Fla. , on 2 April 1956. The course con- 
sists of approximately 6 months of academic instruction in aviation med- 
icine and flight indoctrination training, and leads to the designation of 
successful candidates as U.S. Naval Flight Surgeons. 

The class will be limited to 30 students and is open to medical 
officers of the Regular Navy and Naval-Reserve in the ranks of Lieutenant 
Commander or below. 

Medical officers who wish to apply for the Course in Aviation Med- 
icine should do so by official request via the chain of command to the 
Chief of the Bureau of Medicine and Surgery which shall contain this 
service agreement: "If this request is approved, I agree to remain on 
active duty for one (1) year upon completion of the Course in Aviation Med- 
icine, or for six (6) months beyond my currently obligated service, which- 
ever is longer^ " (AvMedDiv, BuMed) 

****** 

Flight Surgeons to Solo Again 

The Chief of Naval Operations has approved the request of the Com- 
manding Officer of the Naval School of Aviation Medicine and the Chief of 



38 



Medical News Letter, Vol. 26, No. 12 



Naval Air Training to allow the authorization for student flight surgeons 
to solo naval aircraft. Those studeht naval aviators who are physically 
qualified in accordartce with the standards of Service Group I will be 
allowed to solo the T-34 aircraft during the aviation indoctrination portion 
of their training. 

jjC ?^ ?jt 3^ ?^ ?^ 

Opening for Flight Surgeon for Training Leading 
to Designation of Naval Aviator 

There will be an opening in 1956, for a flight surgeon to take advanced 
training leading to the designation of Naval Aviator. Applications for such 
training are requested by the Aviation Medicine Division, Bureau of Med- 
icine and Surgery, Navy Department, Washington 25, D. C. , to be submitted 
by all interested flight surgeons who are physically qualified in accordance 
with the Manual of the Medical Department, Chapter 15-67. 

it; s{E 4: 4 * 
Joint Committee on Aviation Pathology 

The Department of Defense has approved the establishment of a central 
coordinating joint committee on aviation pathology under the Armed Forces 
Institute of Pathology. The membership shall include representatives of 
applicable organizations within the Department of Defense, and, with the 
concurrence of appropriate authority, representatives of the military 
services of the United Kingdom and Canada. 

Stimulated by the lack of knowledge on the subject of aviation path- 
ology, a series of informal meetings was held by representatives of the 
military services of the United Kingdom, Canada, and the United States 
during 1954. In March 1955, with the official concurrence of these med- 
ical services, a symposium on "The Pathological Correlation of Aircrew 
Fatalities" was held at the Armed Forces Institute of Pathology. The 
general agreement of the value of this meeting and the need for more 
information in this field emphasizes the requirement for coordinated action 
among the military organizations of the United Kingdom, Canada, and 
the United States. 

The Joint Committee on Aviation Pathology will be concerned with 
all matters relating to the role of pathology as applied to aviation and 
flight safety, and will act as a focal point for the dissemination of, infor- 
mation on this subject. The special areas of interest are: 



Medical News Letter, Vol. 26, No, 12 



39 



1. Collection of information regarding the correlation between 
pathological evidence and causative factors of aircraft accidents. 

2. Initiation of detailed pathological investigations which may 
yield information relating to the cause of hitherto unexplained 
aircraft accidents. 

3. Improvement of flight safety records as a result of pathological 
correlation data. 

4. Investigation of possible insidious changes induced by repeated 
and long duration exposure to environmental factors and forces 
present during flight. 

5. Establishment of a long range program involving the accumulation 
of pathological data from a large series of cases. 

6. Investigation of psychological and physiological factors which 
may produce pathological changes as a result of flight stresses. 

The membership of the Committee shall not exceed two representatives 
from the Washington, D. C. area of each of the following organizations 
within the Department of Defense, together with invited representatives 
designated by the United Kingdom and Canada: United States Army, United 
States Navy, United States Air Force, and Armed Forces Institute of Path- 
ology. 

The chairman shall be chosen by the members of the Committee and 
the chairmanship shall rotate annually among the member agencies. Meet- 
ings will be held in Washington, D. C. , at the discretion of the chairman 
and the Committee, A member representing the Armed Forces Institute of 
Pathology will act as recorder for the Committee and will provide clerical 
assistance as required. All inquiries or requests for information relative 
to the activities of the Joint Committee on Aviation Pathology should be 
addressed to the Armed Forces Institute of Pathology, Washington, D. C, 

The Departments of the Army, Navy, and Air Force will designate 
as their representatives one or two members representing their respec- 
tive medical services. The names of these representatives will be sub- 
mitted to the Director, Armed Forces Institute of Pathology, who will 
also appoint one or two members of the Armed Forces Institute of Pathology 
to the Committee. Members of the Joint Committee on Aviation Pathology 
may invite observers to meetings of the Committee from their own or other 
interested agencies. 

The Armed Forces Institute of Pathology shall maintain a file of 
the findings of the Committee. Abstracts of these findings and Committee 
reports shall be made available to member agencies and, when appropriate, 
to medical and research activities of other Government agencies which have 
an interest in such matters. 



*3k s!^ 3b ^ 
^ft. rp 



40 



Medical News Letter, Vol. 26, No. 12 



Contributions Req uested for Aviation Medicine Section , 
Navy Medical News Letter 



Flight surgeons in the field attached to the fleet are requested to 
submit to the Bureau of Medicine and Surgery (Code 536) items which 
they consider to be of general interest to other flight surgeons. Articles 
will be reviewed and necessary editorial assistance will be furnished by 
this office. 



Please forward requests for change of address for the News Letter to 
Commanding Officer, U.S. Naval Medical School, National Naval Medical 
Center, Bethesda 14, Md. , giving full name, rank, corps, and old and new 
addresses. 



jj; sjc ^ 



Change of Address 



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QlOAtf ox asn 3±V/VI!Jd aod AXnVNSd 



•D -a 'SZ NO±ONIHSV«V 
AAVN 3HX dO J.N3WX*lVd3a 



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